Tag Archives: ocular motility

The most recent Review of Optometry has three news items emphasizing the importance of infant and child eye and vision evaluation– not just a screening done by the pediatrician or school nurse.

The first describes how retinoblastoma, a rare but potentially fatal eye cancer found in children, can be detected by the appearance of a white pupil in baby photos. It used to be thought that early stage eye cancer couldn’t be detected this way, but a recent study found that early disease in a child as young as 12 days can be visible as a white pupil.

When treated early, retinoblastoma is often curable.

Next, a new study shows that in children with autism, changes in visual behavior can be

Using eye-tracking technology, researchers found that infants later diagnosed with autism showed a decline in attention to others’ eyes by two to six months of age.

detected in the first few months of life. The children that were later diagnosed with autism started out showing normal eye contact with caregivers, but over the next several months their eye contact decreased. Decrease in eye contact began somewhere between two and six months of age. Since the social interaction (eye contact) started out intact, it suggests that there may be another opportunity for early intervention in autism.

Finally, researchers in Sweden discovered that children born before 32 weeks gestational age had a much higher– up to 19 times– risk for retinal detachment by adolescence or young adulthood. The risk for retinal detachment increased with age. So for children born prematurely, it’s very important to have annual dilated eye examinations. It’s also critical to know the signs and symptoms of a retinal detachment: sudden onset or sudden increase of floating spots in the vision, which may look like hairs, cobwebs, or debris in the visual field; flashes of light in the affected eye; and what may look like a curtain or shadow over part of the visual field. If a person notices any of these symptoms, it’s critical to contact an eye care provider immediately. A retinal detachment is an emergency, and the sooner it can be repaired, the more likely the person’s sight can be saved.

If you have any concerns about your child’s developing vision, the first step is a comprehensive eye and vision evaluation. The American Optometric Association sponsors a public health initiative called InfantSEE, which provides no-cost examinations to children between 6 and 12 months of age. Infantsee.org can help you find a participating provider in your area. Yearly eye examinations are also now covered by all insurances as an essential benefit for children under 19 as a part of the Affordable Care Act.

At the Vision & Conceptual Development Center, we provide evaluation and non-invasive, non-surgical treatment for a variety of vision disorders, including Convergence Insufficiency, Strabismus (eye turn), Amblyopia (lazy eye), problems with tracking, Visual Perceptual disorders, and visual anomalies secondary to developmental delay, autism, concussion, stroke, or brain injury. We are also InfantSEE providers.

“I really want to make others aware of vision therapy because I know there must be many children out there who’ve just been labelled slow readers (or disruptive, ADD, etc.) when in fact they have vision difficulties. I hope I can help spread the word.”

It’s always nice when research proves the benefit of what we’ve already been doing in clinic.

For the last several years, as e-readers have become more prevalent, I have been recommending them to many of my patients. In our clinic, we have found that by increasing the font size (which also increases letter/word spacing and decreases the number of words per line), many of our vision therapy patients report that they can read more quickly, with better comprehension and less fatigue.

So I was quite pleased to hear an NPR story a few days ago about a study described in the journal PLOS ONE. Researchers had dyslexic students read on specially formatted iPods or printed text. For many of the students, reading on the iPods (limited to about 3 words per line) greatly improved their reading speed and fluency.

The lead researcher, Matthew Schneps, director of the Laboratory for Visual Learning at the Harvard-Smithsonian Center for Astrophysics, postulates that the mechanisms involved include visual attention span; saccades (the small word-to-word eye movements we make when reading); and visual crowding. By limiting the amount of text per line, deficiencies in those areas don’t have the same effect as when a person reads a normally printed page.

What I find interesting is that in the article, there was no mention of whether these students had had a comprehensive vision examination to look for oculomotor dysfunction, convergence problems (excess or insufficiency), or other binocular vision disorders. In numerous other publications, there have been links between dyslexia and eye movement disorders and binocular vision problems. In many studies of learning disabilities and vision disorders, it has been found that up to 70% of students who have been diagnosed with a learning disability have a vision problem that may be causing or exacerbating that learning difficulty. It would be interesting to see whether the population described in Dr. Schneps’s study has a similar incidence of vision problems.

Fortunately, vision therapy has shown to be a very effective tool in eliminating the underlying visual problems that interfere with reading and learning. And in the meantime, an iPod fits neatly in your pocket.